February 5, 1999
New UW research center asks tough questions to help policy makers with decisions about health workforce issues
More than 9 million Americans are directly employed in health care. Over the past few years the numbers of almost every type of health-care professional, including doctors and nurses, have climbed. Each year medical care is a bigger slice of the U.S. Gross National Product.
These rising figures on spending and staffing don’t necessarily translate into an optimal health workforce to care for the nation. The question arises: Does the United States have the right mix of health professionals, with the right training, working in the towns, cities and neighborhoods where they are most needed?
Researchers at the new WWAMI Center for Health Workforce Studies are looking at the availability, education, distribution, practice patterns and licensing of health professionals as well as many other factors that shape the region’s health workforce. They are creating models to better understand the present nature of the health workforce in Washington, Wyoming, Alaska, Montana and Idaho and to predict future supply and demand in the WWAMI states. They also are determining how workforce issues affect the health of children and other groups.
Two family medicine professors, Dr. Gary Hart, a medical geographer, and Dr. Roger Rosenblatt, a physician, head the center, funded by a three-year, $750,000 grant from the Bureau of Health Professions. “We would like this research to lead to meaningful government and higher education policies,” Rosenblatt said, “to assure appropriate use of resources and ensure that people receive adequate care.”
The center will work with several government and health officials in the WWAMI states to collect and analyze workforce data important for setting state, regional and federal policies. Together they will create descriptive and predictive workforce models, and assess the relationship between workforce maldistribution and the lack of health care in inner-city, suburban industrial and rural areas.
The center is unusual in bringing together many health professions, such as dentistry, nursing, health-care administration, medicine, and allied health fields, as well as experts in economics, geography and other social sciences, to study health workforce issues in partnership.
“These professionals contribute many different talents and bring a lot of firepower to bear on health workforce studies,” Hart said, “because it’s a topic that truly crosses all health and social sciences disciplines. It’s a significant public issue.”
“The WWAMI states, like most states in the nation, heavily invest in the education of health care providers,” Rosenblatt said. “Government and higher education leaders need solid evidence to influence training policies.” A major tension in the health workforce, according to Rosenblatt, occurs because of overlap in patient-care responsibilities among the health professions, what Rosenblatt calls the “who should do what to whom when?” debate. He hopes the research center’s data will help resolve some arguments over who is the appropriate professional to provide necessary health services.
In addition to focusing on curative services, the center will also look at preventive, public, environmental and dental health services. Hart said the center will quantify the benefits and savings from investing in those sectors.
Some of the center’s projects include: models to determine the adequacy of primary-care providers for populations within small geographic areas; physician assistant productivity in various practice settings; distribution of the dental workforce and whether it meets dental health needs; contributions of nurse practitioners, physician assistants and certified nurse midwives to primary care in medically underserved areas; and the effects of an expanded public health agenda on the requirements for public health professionals.
“We realize that we will be walking into the minefields of controversy in our research: Medicare funding of physician training, professional and economic competition, the setting of higher education policy, the allocation of educational funding, licensing regulations,” Rosenblatt said.
“However, we believe that, because hard decisions will have to be made, it is better to make them with the most precise data that can be gathered and in a way that makes the most rational sense. We’re here to ask the tough questions.”
